SELECTION OF PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION FOR THE CATHETER-BASED RENAL SYMPATHETIC DENERVATION

摘要

Purpose: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD). Materials and methods. We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3-5 component hypotensive therapy. At the background of this therapy we conducted 24-hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24-hour blood pressure (BP) was above 150 and 100 mm Hg, and 24-hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months. Results. Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24-4 hour systolic and diastolic BP significantly decreased from 173.9 +/- 14.9 to 143 +/- 21.3,.< 0.05, and from 108.2 +/- 8.7 to 91.4 +/- 13.8 mm Hg., p < 0.05, respectively. Index of elevated systolic BP time decreased from 78.2 +/- 14.6 to 49.8 +/- 29.6 %,p < 0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression. Conclusion. While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).